How Many Revenue Cycle FTES Do You Need?

Jim Matthews RCM & Healthcare Financial Management Consultant
Jim Matthews, Principal, Nearterm Corporation

Revenue cycle staffing patterns and ratios are all over the map among provider organizations. This makes sense when you consider that there are variables like technology, volume, patient type, payor mix, skillset, organization structure, mission and management practices. Hospitals often rely on benchmarks in conjunction with staffing decisions. Benchmarks do very little to recognize these variables in a useful way so they are generally not a universally reliable gauge for staffing decisions. However, there are some cases where all of these variables are homogeneous therefore lending credibility to the use of benchmarks for comparative analysis.

A more scientific approach that is globally applicable requires decision making based on the relationship of labor allocation to work arrival. This approach requires (a) full understanding of volumes in terms of type, arrival timing, processing requirements by type etc. and (b) realistic understanding of labor capability and availability at given times. The goal is to match labor allocation as precisely as possible to work arrival so that volumes are processed in a timely manner and productivity is maximized. The following is a hypothetical illustration of how this concept might be applied in various functional areas around the revenue cycle although the concept is applicable in almost every area.


Patient accounting offices usually operate based on a five day work week.  Labor allocation in billing is the same each of the five days of the week (e.g. 8 to 5 Monday through Friday). However, the hospital is a 24/7 business and there is patient volume every day. When the billing team arrives on Monday, they have 3 days billing volume in their queue. If they can complete 3 days of volume on Monday, productivity is “x”. When they arrive to work Tuesday through Friday, they have only 1 day of volume each day so productivity is “X-2 days volume” and remains at that level through Friday. How is the change in productivity reconciled? Another scenario is that if they do not complete the 3 days volume on Monday, the hospital has a backlog until later in the week, assuming they caught up by the time they leave Friday at 5:00.


Flex staffing pattern to allocate labor to work arrival time:

  1. More hours are scheduled for Mondays, tapering down throughout the week based on work arrival
  2. Schedule weekend labor allocation in billing so that labor allocation better matches work arrival

Practical Guidance

The above is an illustration based on assumptions about volume and staffing patterns. It is intended for conceptual design that can be implemented using an engineering approach. Every hospital has to adapt this design in a way that recognizes their operating environment. It requires comprehensive understanding of volumes. However, we have applied this principal of “labor allocation to work arrival” in many hospitals successfully. It works in patient access, billing, follow-up, and most volume driven areas.

Jim Matthews
Principal, Nearterm Corporation

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The Rise of the Agile Workforce

The Rise of the Agile Workforce

Long gone are the days when people work the same job until retirement. Today, the workforce has transformed, and more and more people are choosing to be “agile” workers — that is, taking on jobs on a project-by-project basis. This rise in the agile workforce means that people have the opportunity to work for a multitude of employers and on a multitude of endeavors in a multitude of settings. The rise of the agile workforce can be attributed to many factors, including the benefits this work structure offers workers — and, also, if you work in the healthcare industry, you may just benefit from burgeoning agile workforce, too.

The Basics of Agile Working

The most basic tenet of agile working is that workers are not traditional full-time employees. Instead, agile workers can be freelancers who work remotely, they can be contracted workers who only work for the duration of a project, or they can be temporary workers who are only staffed for a certain amount of time.

The Agile Workforce by the Numbers

While some companies continue to maintain traditional employees, studies are showing that globally, employers are shifting towards hiring agile workers. A 2016 report by the Freelancer’s Union showed that 35 percent of the total U.S. workforce is made up of freelancers. Further, a recent study by HR consultancy Randstad showed that nearly 11 percent of the global workforce is made up of agile workers. Additionally, 39 percent of workers who are currently full-time employees say that they plan to leave their permanent position and join the agile workforce in the near future. Based on the study, Randstad predicts that 50 percent of the workforce could be agile by 2019.

Reasons Behind the Rise

There are several significant factors that have led to the rise of the agile workforce. First, millennials, who have grown up on the internet and with access to a wide variety of digital communication tools don’t want limitations on their career. Instead, they are drawn to work opportunities that expose them to a wide variety of people, places and fields. The Randstad study also showed that 56 percent of workers felt that they were able to earn better money by working for multiple employers.

How Employers (in General) Can Benefit from the Agile Workforce

It’s clear that workers can benefit from the agile workforce trend — but if you’re an employer, what’s in it for you? First, an agile workforce results in happier employees- and thus, more productive ones. Studies show that 80 percent of employees consider telework a perk from a company, and that 37 percent would take a 10 percent pay cut if they could work from home. Ultimately, hiring an agile workforce can save you money: it reduces brick and mortar costs of having to house and equip full-time employees, and it ensures you only staff people when you need them — and not when the workload is low (or slow).

How Healthcare Organizations Can Benefit from the Agile Workforce

Like other employers, healthcare organizations can greatly benefit from hiring workers on an as-needed basis. The staffing needs of healthcare organizations change regularly, based on a wide variety of factors, including changes in the economy, changes in policy, work volume and more. By not hiring full-time healthcare employees, but by simply finding qualified contract workers when needed, healthcare organizations can take advantage of workers who are excited to work for them — and ensure that they’re not spending excess money to pay people they don’t need (and who aren’t necessarily happy to be there).

If you run a healthcare company and you want to move to an agile workforce, you can rely on Nearterm’s 360? RCM Managed Services. We can help you meet your staffing needs by providing you with qualified workers who can fulfill your positions, as-needed.

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Does Your Revenue Cycle Team Approach Billing and Collection Efficacy the Same Way They Approach Their Paychecks? Why Not?

Jim Matthews RCM & Healthcare Financial Management Consultant
Jim Matthews, Principal, Nearterm Corporation

I expect that if one of your employees’ paychecks were delayed or underpaid, they would be resolute about getting the problem resolved right away. When inquiring about the problem, they probably would not be accepting of “it is in process” or “we did not get your time report” or how about “please leave a message and we will get back to you within 48 hours.” On the contrary, they would be more likely to drop everything and demand immediate action. This is understandable. They have worked hard and they are entitled to be paid every two weeks like clockwork. After all, they have bills to pay.

Here’s the thing: the hospital provides excellent patient care and like the hypothetical employee, the hospital is entitled to be paid correctly and on time. The hospital cannot deposit delays and promises any more than the employee can.

It is important here to recognize that the complexities associated with capturing hospital revenue and converting hospital revenue into cash are enormous compared to managing payroll – I get that. But, conceptually, the analogy I have offered is relevant to the kind of ownership thinking and culture that can make a big difference in Revenue Optimization performance.

If your team does not connect every Patient Account and Revenue Cycle related activity with the hospital’s paycheck and behave with the same tenacity as if it were their own, find out why. You might hear responses that lead to high impact educational opportunities and/or learn more about the culture of your organization and the individuals in it.

In 2007, my company, Nearterm Corporation embraced the importance of ownership mentality at every level in our organization. We introduced more advanced training programs, upgraded technology and reorganized. We formed an Employee Stock Ownership Plan (ESOP) that allowed employees to vest as shareholders – they could actually become owners. Our associates began to function like owners, not just employees. They understand that client service excellence drives not only the company paycheck but theirs as well: they connect the dots!

The result for us is marked by excellent service to our clients, greater attention to detail, enhanced teamwork, creative thinking and steady profitability since inception. But maybe one of the strongest indicators of our success is that our hospital clients have recognized the ability of our consultants to quickly assimilate their business challenges and approach them as their own. Our people own their paychecks, the company’s paychecks and treat client engagements as if they own that client’s success as well. It really is a mentality, a way of thinking that works universally.

Every organization is different but a strategy that promotes ownership thinking is, in my opinion, critical regardless of tactics that are driven by those differences.

Contact us today for help with your hospital revenue cycle management.

Jim Matthews
Principal, Nearterm Corporation

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Medical Coding Managed Services

Medical Coding Services

Do you have a medical coding backlog?

Are you behind on your coding audits?

Need a Coding Audit Program?

Never fear, Nearterm is here!

We help healthcare organizations meet their coding and coding audit needs as part of our overall 360 RCM Managed Services.  Our national client base includes hospitals, clinics and other provider types. All of our medical coders and auditors are credentialed, certified, vetted, professionally managed, and located in the United States. Nearterm coders are held to productivity and accuracy metrics that exceed industry standards.

In addition to the medical coding services described above, Nearterm also provides leadership, implementation support and project management services for all RCM activities and projects. We offer a comprehensive 360 solution from patient access to accounts receivable resolution. Nearterm resources can work from remote locations and/or onsite, whatever your organization requires of them. Nearterm can deliver top notch talent for:

  • Interim Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Consulting (Discovery, Research, Analysis, Planning, POA, Implementation Support)
  • Technicians (Billers, Collectors, AR Specialists, Coders)

If you need help, Nearterm is ready to deliver! Ask A Nearterm Expert.

About Nearterm

Established in 1997, Nearterm is an employee-owned, professional managed services company providing expert revenue cycle management (RCM) and financial management services to hospitals and healthcare organizations nationwide.


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